VOICES / A FORUM FOR COMMUNITY ISSUES

Freud's Ideas and Mental Health Care

* As a practicing psychiatrist and psychoanalyst, I was saddened to read "Freud Slips as an Icon of Science" (May 15). Psychoanalysis is very much alive. How else can we explain that the number of psychoanalytic training institutes in Los Angeles that meet national and/or international standards has doubled in the past 10 years? How else can we explain a 1999 article by world-renowned neuroscientist Eric Kandel, in which he claims that neurobiology requires psychoanalysis in order to understand the complexities of human interaction that can account for mental disorder and successful treatment?

Medication has become increasingly helpful in psychiatric care, but claiming to explain psychiatric illness exclusively as a matter of "altered brain chemistry" can be a profound disservice to the many troubled people who need both medication and psychoanalytically informed psychotherapy. Freud's ideas revolutionized our thinking about psychic distress. To resort to "cheap shots" such as this article contains is to make light of both the value of psychoanalytic thought and of the responsible criticism of Freud's ideas that have enriched psychoanalysis and enhanced our ability to be helpful to our patients.

HARRY R. BRICKMAN MD, PhD

Los Angeles

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Your otherwise accurate and informative article suffers from the message that there are only two approaches to treating mental disorders--psychoanalysis (and its offshoots, including what you refer to as "short-term psychotherapy") and psychoactive drugs.

What you omitted is cognitive behavior therapy, a set of techniques and theories that eschews the unverifiable speculations of psychoanalysis and focuses instead on direct methods of altering behavior, emotion and thought that are based on scientific psychological findings. Both the American Psychological Assn. and the American Psychiatric Assn. have endorsed many of these newer approaches as both more effective and more efficient than therapies based on Freud. In many instances (as in the case of anxiety and mood disorders), cognitive behavior therapy is equal, if not superior, to psychoactive drugs and without the often serious, long-term side effects of these medications.